Venlafaxine During Electroconvulsive Therapy Is Associated With the Postictal Administration of Antihypertensive...

Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression and commonly administered with concomitant antidepressant medication. ECT is associated with short-lived and self-limiting changes in blood pressure. Thus, additional medications that potentially elevate blood pressure, such as antidepressants with noradrenergic effects, might be of special concern during ECT.

We retrospectively analyzed data from patients in which the same patient received some ECT sessions with and some without concomitant venlafaxine medication. To assess whether concomitant venlafaxine medication increased the likelihood that patients required antihypertensive medication after ECT, we used mixed-effects logistic regression. We restricted our analysis to high-risk patients with at least 1 recorded systolic blood pressure >200 mmHg during their ECT series.

We identified 56 patients who received some of their ECT sessions with and some without concomitant venlafaxine, in total 1173 ECT treatments. Among these, 40 patients had at least 1 systolic blood pressure measurement >200 mmHg. The 396 ECT treatments of these 40 patients were further analyzed. The odds for postictal administration of antihypertensive medication in the treatment room were significantly higher when patients received concomitant venlafaxine medication (odds ratio, 5.46; P = 0.015) and in older patients (OR, 3.28; P = 0.019).

Concomitant venlafaxine medication could increase the likelihood that patients need antihypertensive medication during ECT treatment, especially patients at high risk for hypertension. Clinicians should be aware of this association and consider either adjusting the venlafaxine dose or adapting the timing of its administration during an ECT series.